Coronavirus/COVID-19 ‘Unlikely To Be Contained Before The End Of 2020’ Says CDC

BEIJING, CHINA - FEBRUARY 14: A Chinese security guard wears a protective mask as he stands in a nearly  empty subway car during rush hour on February 14, 2020 in Beijing, China. The number of cases of the deadly new coronavirus COVID-19 rose to more than 55000 in mainland China Friday, in what the World Health Organization (WHO) has declared a global public health emergency. China continued to lock down the city of Wuhan in an effort to contain the spread of the pneumonia-like disease which medicals experts have confirmed can be passed from human to human. In an unprecedented move, Chinese authorities have maintained and in some cases tightened the travel restrictions on the city which is the epicentre of the virus and also in municipalities in other parts of the country affecting tens of millions of people. The number of those who have died from the virus in China climbed to over 1380 on Friday, mostly in Hubei province, and cases have been reported in other countries including the United States, Canada, Australia, Japan, South Korea, India, the United Kingdom, Germany, France and several others. The World Health Organization has warned all governments to be on alert and screening has been stepped up at airports around the world. Some countries, including the United States, have put restrictions on Chinese travellers entering and advised their citizens against travel to China. (Photo by Kevin Frayer/Getty Images)

On Friday, the CDC latest risk assessment indicated that the 2019-novel coronavirus epidemic was unlikely to be contained before the end of 2020. That was one of several gloomy predictions in the last 48 hours, as the number of cases in China continues to grow and totals tick up slowly, but seemingly inexorably, in countries like Japan and Singapore.

And then there was this statement from a Harvard epidemiologist in a Wall Street Journal article. “I think it is likely we’ll see a global pandemic. If a pandemic happens, 40% to 70% of people world-wide are likely to be infected in the coming year.” That statement is … well, pretty terrifying. It’s also backed by some terrifying math, including the idea that not only are the number of cases being reported in China only 10% of the real total, but that cases outside of China might only represent 25% of what is really happening.

And, unfortunately, we have a floating experiment that may prove they are right.

When looking at cases outside China, the first location that becomes an obvious red flag is Japan. Official tallies list only 49 cases, but that number seems to be excluding four cases that have, so far, been asymptomatic, as well what is now 285 people aboard the Diamond Princess cruise ship. But even disregarding the ship and the over 3,000 people still waiting for some resolution, there has been a steady drumbeat of additional cases in Japan. That includes 8 cases in a single day from Tokyo, at least some of which are connected to a taxi driver who attended a party with nearly 100 guests. The number of secondary and tertiary infections in Japan, unrelated to someone who had been in China, is seriously concerning.

But Japan is about to get some relief, as American passengers are going to be removed from the Diamond Princess in the next couple of days and flown on chartered flights straight into quarantine in the states. More details on that operation when they’re available. One issue: only those passengers who have tested negative for coronavirus will be allowed on the flights. And they have to be tested for a good reason—at least half of those who have tested positive for coronavirus on the ship have had no symptoms.

This is a reversal of what’s happening in most areas “in the wild,” where people demonstrate symptoms, are tested, and cases are tallied. The situation on the Princess involves people who are being tested, despite not having symptoms, and many of them are still found to be carrying the virus. That’s a big boost to the “lots of undetected cases” theory. Not only are there people whose symptoms are mild enough they may not be reported, there are apparently a sizable number with essentially no symptoms at all. What’s not clear — how great a threat these asymptomatic cases remain for passing COVID to others.

Other areas with similar numbers of cases have also had some bursts of cases. Singapore reported new new cases over night, but on February 14 they had 9 cases come in, most of them related to a church that has now been connected with 13 cases.  With 67 cases, they’re right with Japan in terms of developing new epicenters outside of China. Though if you wanted to pick two spots to combat an infection—it would be hard to do better than Japan and Singapore.

There’s been some concern expressed in comments about travel between China and Africa, as Chinese companies have made a major play for both African resources and infrastructure projects over the last year. On Friday, Africa had it’s first reported case of COVID-19, with the Egypian ministry of health reporting that a “foreign person” had tested positive for the virus and would be in “self-imposed” isolation for 14 days. It sounds as if this person is being trusted to simply stay at their own residence … which seems a tad concerning, but the situation may not be quite what I’m getting translating the Facebook page of the ministry.

Another unwelcome first overnight came in the form of the first COVID related death in Europe. This was a Chinese tourist who became ill while in France, so not a local infection, but still an unwelcome sign. In exchange, here’s a good one — all three cases that had been known in India are now listed as recovered.

Okay … the big numbers.

Since the big jump on Thursday, cases have again flattened out. That was especially true for the latest provincial report from Hubei, which shows 2,420 total cases, but only 1,282 that were lab-confirmed. If the province had not begun adding in clinical cases, I would now be painting a very cheery picture, as 912 cases were listed as recovered.

Even with the clinical cases included, it really does look as if Hubei has worked through a lot of the backlog.

As mentioned yesterday, China rolled back most of the other frightening statistic on Thursday by subtracting 108 deaths as “double counted.” And yes, we’re pretty sure this is not a World War Z scenario.

Outcomes still haven’t reached that turnover point where more people are recovering than getting sick.

The big influx of clinical cases actually drove the case fatality rate down temporarily, but it’s again trending slowly upward.

Meanwhile, outcome mortality continues marching downward. When all the books are closed, these two numbers will meet — hopefully somewhere at or below the current case fatality rate.

So, are there really hundreds of thousands of people infected with coronavirus, many of them wandering outside of China? That’s what the math would indicate and the “experiment” of the Diamond Princess would seem to suggest. On the other hand, there doesn’t seem to be a sign of these hidden cases generating the additional epicenters that would be expected. Clearly, we don’t yet understand everything going on here.

For the moment, health care systems outside of Hubei seem to be holding their own, and once again the healthcare system inside Hubei might be glimpsing a little light at the end of a long, dark tunnel. That will have to do for now.

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